When would you recommend adding peritoneal dialysis to a patient with oxalosis who is already receiving hemodialysis?

Tang et al., PMID 24776840

I have never done this. The amount of oxalate cleared by peritoneal dialysis is a very small fraction of the amount cleared by hemodialysis. In general, among patients with oxalosis, the oxalate is well cleared from the blood on hemodialysis, but oxalate has a very large volume of distribution. Thus the oxalate clearance falls markedly over 4 hrs. The best strategy for aggressive oxalate removal is daily dialysis of shorter times (e.g. 3 hrs). On PD, even if you have complete equilibration, the amount of oxalate removed with each exchange is limited by the volume of peritoneal dialysate. As an aside, typical home hemodialysis regimens are also not very good for oxalate clearance in primary hyperoxaluria due to the ...